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AN  ;  :,,•,/:  '■ ' ; 

INAUGURAL   DISSERT  Ati®^ 


ON      THE 


SCARLATINA  ANG1N0SA, 

AS  IT  PREVAILED  IN  THIS  CITY. 


SUBMITTED    TO    THE    PUBLIC    EXAMINATION 
OF       THE 

FACULTY     OF     PHYSIC, 

UNDER    THE    AUTHORITY    OF     THE 

TRUSTEES    OF    COLUMBIA    COLLEGE 

IN      THE 

STATE  OF  NEW-YORK: 
WILLIAM  SAMUEL  JOHNSON,  LL.D.  Prefident; 

FOR  THE  DEGREE  OF 

DOCTOR    OF    P  H  Y  S  I  C; 

ON  THE  THIRTIETH   DAY  OF  APRIL,    I793. 


By  WILLETT  TAYLOR,  junior, 

Citizen  of  the  State  of  New-Yofk. 


MISERIS    SUCCURRERE    DISCO. 

VIRG. 


N  E  W  -  Y  O  R  K  : 
Printed  by  T.  and  j.  Swords,  Printers  to  the  Faculty  of   Phyfic  of 

Columbia  College,  No.  27,  William -Street. 


— x793 — 


Imprimatur. 


•52. 


Gul.  Hamerjley, 

Med.  Theoret.  Profeffor. 


SAMUEL   BARD,   M.D. 

Dean  of  the  Faculty  of  Phyfic 

?N   COLUMBIA   COLLEGE, 

N  E  W- Y  O  R  K: 

THIS 

DISSERTATION 

Is  refpe&fally  infcribed, 

jfy  bis  obliged  Friend, 
And  humble  Servant? 

The  AUTHOR. 


,C  tJ  /&  *J  « 1  *■  * 


_  A .    -  -'  •     »  *     *    "  »        >       o    t 

INAUGURAL  DISSERTATION 


ON        T    H    S 


SCARLATINA  ANGINOSA, 


AS  IT  PREVAILED  IN  THIS  CITY. 


V>ONTAGIOUS  difeafes,  from  their  firft  ap- 
pearance, have  proved  fo  deftruclive  to  mankind, 
that  any  attempt  to  investigate  their  real  nature, 
mult,  be  coniidered  as.  not  only  laudable,  but  as  a 
duty  highly  incumbent  on  thofe  who  are  intrufted 
with  the  lives  of  their  fellow  citizens. 

This  difeafe  has  lately  appeared  as  an  epidemic  in 
this  city,  and  frill  continues  fo  at  the  prefent  time. 
From  the  variety  of  appearances  which  it  has  af- 
fumed,  it  has  engaged  the  attention  of  Phyficians ; 

among 


(    6    ) 

amotig  whom  there  has  been  a  difference  of  opinion. 
Some  have  fuppofed  the  fever,  which  accompanies 
this  difeafe,  to  he  of  an  inflammatory  nature  -,  whilfl: 
others  'have,  confidently  aflerted  that  it  was  a  real 
Typhus. 

I  mail  here  attempt  a  defcription  of  the  Scarlatina 
'Anginofa^  as  it  appeared  in  this  city,  with  that  diffi- 
dence which  becomes  a  young  Practitioner ;  not  de- 
pending altogether  upon  my  own  judgment,  but 
viewing  it  as  fanctioned  by  men  who  are  eminently 
diftinguifhed  in  this  department  of  fcience. 

A  defcription  of  this  difeafe  is  not  to  be  found  in 
the  writings  of  Hippocrates ;  and  as  the  exanthe- 
matic  fevers  were  only  confidered  as  varieties  of 
febrile  difeafes,  we  confequently  meet  with  no  ac- 
curate account  of  the  fcarlet  fever  until  the  {qvqii- 
teenth  century  -,  becaufe,  previous  to  that  period, 
medicine  had  never  appeared  in  fyftematic  form. 
Sydenham,  in  his  writings,  has  defcribed  a  fever 
under  this  name,  but  without  any  affection  of  the 
throat :  his  defcription  may  therefore  anfwer  to  the 
Scarlatina  Simplex  of  Doctor  Cullen. 

It 


(    7    3 

It  is  afferted,  that,  in  the  year  1689,  it  prevailed 
as  an  epidemic  in  London.  Doclor  Morton  fpeaks 
of  it  in  his  Pyretologia.  He  thinks  it  differs  from 
the  meafles  only  in  the  mode  of  eruption. 

In  the  years  1748  and  1749,  this  difeafe  raged 
at  the  Hague :  it  proved  fatal  to  a  great  number 
of  people.  The  fever  was  evidently  typhus. 
Do6tor  De  Haen  defcribes  it  as  it  fell  under  his 
immediate  obfervation,  and  relates  feveral  cafes.— 
Unfortunately  he  praclifed  blood-letting  very  freely, 
and  was  upon  that  account  very  unfuccefsful  in  his 
treatment  of  the  difeafe. 


Sauvage  defcribes  a  fcarlet  fever,  attended  with 
idcerous  fore  throat,  which  prevailed  at  Montpelier 
in  the  year  1765.  The  difeafe  was  then,  as  it  has 
generally  been  here,  confined  chiefly  to  children. 


Other  authors  have  defcribed  this  difeafe.  Wi- 
thering fpeaks  of  it  as  inflammatory ;  Doclor  Cul- 
kn  feems  to  be  of  the  fame  opinion,  and  terms  it 

Synocka 


(     8     ) 

Synocba  Contagiosa ;  Doctor  M'Bride  conceives  it  to 
be  fbmetimes  inflammatory,  at  others  nervous,  or, 
in  the  language  of  exploded  opinions,  putrid. 

In  the  month  of  July,  1792,  the  fcarlet  fever 
appeared  in  this  city.  It  firft  difcovered  itfelf  in 
fome  narrow  ftreets  near  the  North-River,  where 
the  houfes  were  fmall,  occupied  by  feveral"  families, 
and  badly  ventilated.  From  the  indigent  circum- 
ftances  of  thofe  whom  it  chiefly  afrected,  it ■ was 
Impoflible  they  could  pay  that  attention  to  cleanli- 
nefs  which  was  neceffary  for  the  prefervation  of 
their  health.  It  was  confined  to  this  part  of  the 
city  for  fome  time^  but  at  length  it  fpread,  and 
became  more  general  and  raged  with  peculiar  vio- 
lence in  thofe  parts  of  the  city  where  the  inhabitants 
were  in  the  situation  juft  defcribed.  It  is  alfo  to  be 
remarked,  that  as  the  cold  weather  approached,  it 
gradually  abated  •>  and  as  the  cold  increafed,  it  al- 
moft  difappeared, 


HISTORY 


(     9     ) 
HISTORY  of  the  DISEASE. 


THIS  difeafe  generally  began  with  anorexia, 
naufea,  and  fometimes  vomiting;  great  laffitudc, 
chiilinefs,  and  fhivering :  the  patient  loon  complained 
of  an  head-ach;  and  a  ftifFnefs  was  commonly- 
felt  about  the  neck,  with  fome  uneafinefs  in  the  in- 
ternal fauces.  Upon  looking  into  the  mouth,  the 
velum  pendulum  palati,  tonfils,  and  uvula  appeared 
of  a  red  colour :  as  the  rednefs  increased,  a  number 
of  white  or  afh-coloured  fpots  made  their  appear- 
ance, which  at  length  became  as  many  ulcers. 
Deglutition  was  fometimes  painful  and  difficult,  the 
refpiration  quick  and  laborious ;  but  the  breath  at 
this  ftage  of  the  difeafe  was  not  ofTenhVe :  the 
tongue  was  covered  with  a  white  fur,  and  the  mouth 
and  fauces  loaded  with  mucus.  Thefe  fymptoms 
were  attended  with  fome  degree  of  coryza,  but  not 
fo  much  as  to  prove  troublefome.  The  patient 
was  now  affedled  with  alternate  chills  and  heats,  the 
ikin  grew  hot,  and  the  pulfe  became  rather  hard  and 
full.  There  was  generally  in  the  evening  an  exacer- 
'  bation  of  the  fever,  and  the  patient  grew  reftiefs, 
and  fometimes  delirious. 

B  Upon 


(      io     ) 

Upon  the  third  or  fourth  day  of  the  difeafe,  the 
eruption  made  its  appearance;  the  rednefs  was  firft 
perceived  on  the  face,  neck  and  breaft,  and  extended 
fometimes  over  the  whole  body,  which  became 
very  turgid ;  at  other  times  it  was  not  fo  diffufed ; 
but  very  generally  the  extremities  were  affected, 
and  the  hands  and  fingers  much  fwelled,  and  pain- 
ful to  the  touch.  I  always  found,  that  when  the 
eruption  on  the  furface  of  the  body  was  in  a  trifling 
degree,  the  throat  was  much  inflamed,  and  vice 
verfa.  Some  Practitioners  in  this  city  affert  that 
they  have  {qqu.  a  Scarlatina  Simplex,  but  in  every 
cafe  I  have  found  it  attended  with  feme  degree  of 
Cynancbe. 

Upon  the  appearance  of  the  efHorefcence,  the 
fever  fuffered  very  little  remiffion ;  on  the  contrary, 
it  frequently  increafed :  the  duration  of  the  eruption 
was  uncertain  \  its  colour  was  generally  changed  to 
a  brownifn  appearance  in  three  or  four  days :  the 
fkin  became  rough,  and  a  confiderable  desquama- 
tion took  place  -,  among  fome  it  was  fo  great  that  a 
complete  cuticular  glove  was  taken  off. 


The 


(  II  ) 

The  eruption  would  often  vary  as  to  its  appear- 
ance :  fometimes  it  would  appear  in  fmall  points ; 
at  others,  the  fkin  would  be  fmooth  and  equal  \  and 
now  and  then  fmall  phlogofes  phlegmonodes  difco- 
vered  themfelves,  and  ended  in  fuppuration. 

After  the  defquamation  took  place,  the  fever 
remitted,  and  a  gentle  fweat  came  on,  which  gave 
a  further  remimon  \  the  fauces  looked  better,  the 
ulcerations  foon  healed,  and  the  patient  recovered 
Jiis  ufual  health, 

I  have  now  defcribed  the  Scarlatina  Anginofa  as 
it  appeared  in  its  mild  ftate.     Several  perfons  who 
had  it  in  its  gentler},  form,  fell  into  anfacrous  fwel- 
lings,  and  had  a  hydrops  pectoris.     In  confirma- 
tion of  this  afTertion,  I  beg  leave  to  obferve,  that 
from  the  dirTe&ions  of  people  who  have  died  of 
this  difeafe,  I  can  fay  from  my  own  experience,  that 
there  have  been  ferous  effufions  into  the  cavity  of 
the  bronchia,  as  well  as  into  the  thorax,  which  I 
apprehend  may    have  occafioned   fuifocation;    of 
•   which  three  or  four  cafes  have  fell  under  my  oh- 
fervation. 


Although 


(       12       ) 

Although  the  Scarlatina  frequently  terminated 
favourably,  yet  it  often  proved  fatal,  particularly 
to  children.  I  mall  now  proceed  to  defcribe  it  as  it 
appeared  in  its  moft  dangerous  form. 

The  iicknefs,  which  was  not  very  great  in  the 
Scarlatina  Benigna,  proved  very  diftreffing  to  the 
patient  in  the  Scarlatina  Maligna^  which  was  almoft 
always  attended  with  fome  degree  of  vomiting :  the 
parotid  and  maxiliary  glands  were  confiderably 
fwelled,  and  often  threatened  fuirocation :  the 
coryza,  which  was  fcarcely  perceptible  in  the  one, 
was  very  considerably  increafed  in  the  other :  the 
nofe,  eyes  and  fauces  difcharged  an  acrid  matter, 
which  excoriated  the  noftrils  and  lips  ♦,  palling  alfo 
from  the  fauces  into  the  cefophagus,  it  fpread 
through  the  whole  of  the  alimentary  canal,  ccca- 
iioning  diarrhoea. 

The  ulcers  were  very  numerous,  they  put  on  a 
livid  appearance,  and  the  breath  became  very  offen- 
five.  The  -efrlorefcence  would  fometimes  entirely 
difappear,  or  turn  to  a  dark  or  livid  colour ;  the 
tongue  was  dry,  and  covered  with  a  brownifh  fcurfs 

the 


(  13  ) 

the  refpiraticn  fmall,  hurried,  and  laborious,  at- 
tended with  anxiety,  and  great  oppreilion  about  the 
praecordia :  fometimes  delirium  from  the  beginning 
came  on,  and  continued  through  the  whole  courfe 
of  the  difeafe,  but  generally  did  not  make  its  ap- 
pearance until  the  third  or  fourth  day,  and  often 
not  until  a  frill  later  period  :  the  eyes  foon  loft  their 
luftre,  looked  glafTy,  and  appeared  to  fink  in  their 
fockets :  the  patient  complained  of  great  thirft,  and 
had  a  defire  for  acids.  To  thefe  fymptoms  fuc- 
ceeded  involuntary  difcharges  of  foeces  and  urine. 
The  puife  from  the  beginning  was  fmall,  frequent, 
and  often  irregular.  All  thefe  fymptoms  increafing, 
the  patient  frequently  became  comatofe,  and  in  that 
ftate  expired.  Hiccough,  and  fubfultus  tendinum, 
would  frequently  terminate  the  life  of  the  patient. 

Some  perfons,  during  the  continuance  of  this 
difeafe,  laboured  under  pneumonic  affections.  In 
fome,  the  attack  was  preceded  hy  cholera  \  but  as 
they  were  accidental  fymptoms,  they  were  treated 
as  fuch.  It  has  generally  been  obferved  in  thefe 
cafes,  where  the  flrength  of  the  patient  had  been 

greatly 


(     14     ) 

greatly  exhaufted  from  exceffive  evacuations,  that  by- 
far  the  greater  number  of  them  proved  fatal. 

As  our  different  modern  writers  have  held  dif- 
ferent opinions  refpecting  the  nature  of  the  fever 
attending  Scarlatina  Angtnofay  I  am  induced  to  fay 
fomething  refpecting  it.  Doctor  Cullen  places  this 
difeafe  in  the  clafs  of  Pyrexia,  order  of  Exanthe- 
mata, genus  Scarlatina.  He  makes  two  fpecies. 
His  definition  is, 

"  Quarto  morbi  die,  facies  aliquantum  tumens  -, 
"  iimul  in  cute  paffim  rubor  floridus,  maculis  am- 
U  plis,  tandem  coalefcentibus,  poft  tres  dies  in  fqua- 
"  mulas  furfuraceas  abiens  \  fuperveniente  dein  faepe 
"  anafarca." 

Cujleni  Synopfis  Nofologise  Methodic^,  genus  xxlx. 

The  fpecies  are, 

"  i.  Scarlatina  (Simplex)  nulla  comitante  Cy- 
"  nanche. 

"  2.  Scarlatina  (Cynanchica)  cum  Cy nanche 
"  ukerofa." 


The 


(   m   ) 

The  fever  evidently  appears  to  me  to  be  fyrio- 
chus,  or  typhus ;  the  former  I  hold  to  be  no  more 
than  a  variety  of  the  latter ;  and  Doctor  Cullen, 
after  placing  fynochus  as  a  genus,  acknowledges 
that  he  thinks  it  only  a  variety  of  typhus.  The 
variety  of  the  fever  feems  to  depend  altogether 
upon  the  difference  of  conftitution,  climate,  and 
other  circumftances.  Thus,  if  a  perfon  is  of  a  full, 
robuft  habit,  and  of  a  fanguine  temperament,  he 
may  be  attacked  with  fynochus,  and  the  fymptoms 
will  appear  to  be  inflammatory.  On  the  contrary, 
if  one  of  a  delicate  ftructure  of  body,  or  infirm 
make,  mould  be  feized  with  this  difeafe,  his  fever 
will  be,  more  properly  fpeaking,  typhus,  from  the 
peculiar  {tare  of  his  body  acting  as  a  predifpofing 
caufe. 

Some  authors  contend,  that  the  Scarlatina  Angi- 
na fa  is  a  difeafe  fpecifically  different  from  Cynanche 
Maligna ;  but  this,  certainly,  does  not  feem  to  be 
the  cafe :  If  there  is  a  difference,  it  is  only  m 
degree ;  and  this  mull  depend  altogether  on  the 
circumftances  of  conftitution,  &c.  Dodor  Cullen's 
objection  to  its  being  the  fame  difeafe  as  Cynanche 

Maligna*) 


(     16    ) 

Maligna,  ts  not  fatisfacfcorily  eftablifhed  \  for  he 
fuppofes  the  difference  to  depend  upon  the  fynn> 
toms  being  milder  in  Scarlatina ;  but  I  have  {tQn 
patients  attacked  with  Scarlatina^  in  whom  'the 
fymptoms  were  fo  perfectly  analogous  to  Cymnche 
Maligna^  that  no  line  of  diftinction  could  poffibly 
be  drawn  between  them.  This  has  been  the  cafe 
with  the  greater  number  of  the  perfons  I  have  ktn. 
Some  perfons,  who  were  of  a  vigorous  confuta- 
tion, had  a  flight  attack  of  the  difeafe ;  but  others, 
of  a  debilitated  habit,  v/ere  generally  affected  with 
every  fymptom  peculiar  to  Cynancbe  Maligna.  In 
illuftration  of  what  I  have  faid,  we  may  remark, 
that  the  fmall-pox  will  affect  fome  people  much 
more  violently  than  others  :  Yet  this  difference 
does  not  depend  upon  a  different  fpecific  contagion, 
but  is  merely  a  variety  depending  on  confutation 
and  other  concurring  circumftances. 

I  have  faid,  ia£i  former  part  of  this  DifTertation, 
that  Sydenham  defcrihes  a  Scarlatina  Simplex ;  and 
this  Doctor  Cullen  brings  as  an  argument  in  favour 
of  its  being  different  from  Cynancbe  Maligna.  But 
I  now  repeat,  that  every  cafe  of  Scarlatina  that  has 

come 


(     »     ) 

come  under  my  notice,  has  been  marked  with  an 
affection  of  the  throat.  In  fome,  the  affection  was 
fo  flight  that  it  would  have  readily  efcaped  com- 
mon obfervation.  Doctor  Clarke,  who  has  written 
very  accurately  on  this  difeafe,  never  met  with  a 
cafe  unattended  with  Cynanche.  He  believes  the 
two  difeafes  to  differ  only  in  degree. 

From  fuch  refpectable  authority,  added  to  what 
obfervations  I  have  made,  I  muft  think  that  they 
are  one  and  the  fame  difeafe-,  that  the  diftinction 
is  an  improper  one,  and  ought  to  be  rejected. 


CAUSES. 


THESE  may  be  divided  into  remote  and 
proximate.  The  remote  comprehends  predifpo- 
nent,  and  exciting  or  occafional  caufes.  Thefe  are 
now  to  be  defcribed. 


PREDIS. 


I     *8     ) 

PREDISPONENT  CAUSES. 


Predisposition,  according  to  Doctor  Brown, 
is  that  ftate  of  the  body  which  renders  a  perfon 
fufceptible  of  the  operation  of  the  exciting  or  occa- 
fional  caufe.  This  flate  may  be  brought  on,  fo  as 
to  favour  the  aclion  of  the  exciting  caufe,  by, 

i .  The  perfon' s  being  accuftomed  to  had  diet,  or, 

2.  Scanty  allowance  of  provifions. 

3.  Filling  the  ftomach  with  a  larger  quantity  of 

foolfcthan  it  can  bear. 

4.  Fear,  and  other  deprejfing  paffions. 

5.  Cold  long  continued,  or  combined  with  moifiure. 

6.  Intoxication,  occaftoning  debility. 

7.  Fatigue. 

8.  Any  vicijfitude  of  weather. 

9.  Intenfe  application  to  ftudy,  and, 

10.  Night  watching. 

1 1 .  Too  frequent  evacuations. 
"12.  Previous  difeafes,.  &c. 

In  fhort,  any  thing  that  will  have  a  tendency  to 
debilitate  the  body  gives  a  predifpofition. 

EXCITING 


(  m  > 

EXCITING  CAUSES. 


The  exciting  caufe  of  Scarlatina  feems  to  be  a 
fpecific  contagion,  arifing  from  a  perfon  labouring 
under  the  fame  difeafe,  or  from  fuch  things  as  are 
impregnated  with  thefe  effluvia  -,  and  thefe  fubftan- 
ces,  fo  imbued,  are  called  fomites.*  It  is  obferved, 
that,  with  refpect  to  contagion,  we  know  but  little ; 
that  it  appears  to  be  of  a  fedative  nature,  and  is 
generated  by  the  living  human  body ;  that  if  it  is 
long  retained  in  the  fame  place  without  being  dif- 
fufed  in  the  atmofphere,  it  acquires  a  great  degree 
of  virulence  ;  and  if  then  applied  to  men's  bodies, 
will  produce  a  very  dangerous  difeafe.  To  confirm 
this  opinion,  we  are  defired  to  confult  the  writers 
on  gaol  and  hofpital  fevers. 

It  defer  ves  to  be  noticed  of  this,  as  of  all  other 
contagious  difeafes,  that  certain  (rates  of  the  atmof- 
phere do  unqueftionably  favour  the  propagation  of 
tfi  and  the  increafe  and  decreafe  of  the  diforder, 
together   with  the   more   mild  or   more  virulent 

fymptorns 

*  Cullen's  FIrft  Lines  of  the  Pra&Ice  of  Phyfic,  vol.  i, 


(       20      ) 

fymptoms  which  it  has  aflumed,  within  the  courfc 
of  nine  or  ten  months  part.,  fince  its  appearance  in 
this  city,  according  to  the  changes  of  weather, 
prove,  beyond  all  doubt,  the  truth  of  the  affer- 
tion. 


is 


PROXIMATE  CAUSE, 

A  knowledge  of  the  proximate  caufe  of  difeafes 
efTentially  necefTary  to  be  understood  by  every 
Practitioner,  as  the  cure  immediately  depends  upon 

it. 


From  the  latitude,  inactivity  and  proftration  of 
ftrength,  debility  of  the  animal  functions,  weaknefs 
of  the  pulfe,  anorexia,  nauiea,  vomiting,  delirium, 
the  impaired  flate  of  the  vital  energy  -,  and  laftly, 
from  the  manner  in  which  the  difeafe  frequently 
terminates,  are  we  not  led  to  fuppofe  debility  the 
proximate  caufe  ?  The  different  phenomena  cer- 
tainly evince  it. 

PROGNOSIS. 


(  m  ) 

PROGNOSIS. 


When  the  ulcers  in  the  mouth  and  fauces  were 
few ;  when  they  continued  white,  and  did  not  af- 
fume  a  livid  appearance ;  when  the  tumefaction  of 
the  throat  was  not  great,  if  there  was  but  little 
coryza,  and  a  foft  flow  pulfe,  we  might  predict  a 
favourable  termination.  Upon  the  appearance  of 
the  eruption,  there  was  a  remiflion  of  the  fever ; 
the  defquamation  taking  place,  the  fever  fubfided 
altogether,  and  the  ulcers  healed  kindly.  But 
when  the  ulcers  became  livid,  and  were  numerous; 
if  the  tongue  was  covered  with  a  brown  cruft,  the 
breath  foetid,  with  considerable  coryza  -,  if  the  fever 
was  typhus,  with  a  fmall  weak  pulfe,  and  great  ge- 
neral debility,  our  prognolis  was  unfavourable. 


METHOD 


(    |3    ) 
METHOD  of  CURE. 


I N  the  beginning  of  the  difeafe,  if  the  action'  of 
the  vefTels  appears  to  be  ftrong,  ikin  dry,  counte- 
nance flufned,  with  few  fymptoms  of  debility,  we 
murl:  endeavour  to  reduce  the  pulfe  to  fuch  a  ftand- 
ard  as  will  juftify  our  throwing  in  the  bark.  I 
generally  found  the  adminiftratton  of  an  emetic 
very  ferviceable.  I  preferred  the  tartar  emetic, 
unlefs  the  intention  was  folely  to  remove  crudities 
from  the  fbmach,  when  I  ufed  ipecacuanha.  The 
emetic  tartar  may  be  given  in  fuch  doles  as  to  excite 
full  vomiting,  or  to  naufeate  \  but  as  frequent  vo- 
miting fometimes  brought  on  too  great  debility,  I 
trufted  chiefly  to  the  laft  mentioned  method,  i.  e. 
naufeating  dofes. 

Warm  bathing  I  found  highly  ferviceable. 
When  the  water  was  only  tepid  it  often  brought 
on  a  gentle  diaphorefis,  which  greatly  relieved  my 
patients.  It  may  be  applied  to  the  whole  body,  or 
to  the  extremities  only.  Partial  bathing  anfwered 
every  purpcfe. 

Acids 


(       23       ) 

Acids  are  ufeful  through  every  ftage  of  this 
difeafe,  but  particularly  in  the  beginning,  on  ac- 
count of  their  refrigerant  quality.  Laxatives,  fuch 
as  the  neutral  falts,  were  adminiftered  to  keep  the 
bowels  moderately  open. 

In  this  ftage  of  the  difeafe,  fome  Phyficians  have 
advifed  and  practifed  blood-letting ;  but  this^  like 
almoft  every  other  contagious  difeafe,  did  not  well 
bear  the  lofs  of  blood,  as  it  frequently  increafed 
the  fymptoms  of  debility  very  fuddenly ;  for  which 
reafon  I  never  attempted  it.  If  at  any  time  this 
evacuation  mould  be  indicated,  the  lancet  ought 
certainly  to  beufed  very  cautioufly. 

In  many  cafes  this  difeafe  was  attended  with  ty- 
phus fever  from  its  firft  appearance  -,  and  in  fome 
others  it  foon  aflumed  this  form.  In  thefe  I  im- 
mediately employed  tonics  and  ftimulants.  The 
tonic  which  I  found  to  be  the  beft,  was  the  Peru- 
vian bark.  Although  it  has  been  rejected  by  fome 
Phyficians,  it  is  certainly  one  of  the  beft  medicines 
we  are  acquainted  with.  It  may  be  exhibited  in 
powder  or  infufion.     Sometimes  the  irritability  of 

The 


(     H    ) 

the  ftomach  was  fo  great  that  it  could  not  be  re- 
tained either  way :  I  then  adrniniftered  it  by  clyfter, 
previouily  emptying  the  bowels  with  an  injection  of 
vinegar.  Some  children  have  derived  great  benefit 
from  the  ufe  of  the  bark  waiftcoat. 

Porter,  from  its  containing  a  great  deal  of  fixed 
air,  muft  undoubtedly  be  considered  as  an  excellent 
tonic     and  upon  that  account  ought  to   be  ufed 

freely. 

Cold  has  been  mentioned  by  fome  medical  men 
as  an  ufeful  tonic  •,  they  admitted  it  to  their  pa- 
tients. This  practice  I  hold  to  be  very  erroneous  \ 
and  whoever  will  confult  the  writings  of  Doctor 
Brown  on  the  fubject,  will  immediately  perceive 
that  it  is  a  direct  fedative,  and  highly  improper  in 
afthenic  difeafes. 

Cold  applications  may  alfo  be  confidered,  in 
many  cafes,  as  very  injurious,  by  checking  the 
eruption.  Cafes  of  this  kind  have  occurred,  where 
it  has  really  brought  on  convulfions,  and  ended 
fatally.     Inftead,  then,  of  cold,  frefh  air  ought  to 

be 


(      25      ) 

be  admitted  in  the  patient's  chamber,  for  the  pur- 
pofe  of  ventilation ;  and  in  the  winter  feafon,  a  fire 
may  be  kept  in  the  apartment  of  the  fick. 

Cleanlinefs  ought  to  be  ftricily  attended  to, 
The  bed-clothes  and  body  linen  mould  be  fre- 
quently changed,  all  excrementitious  matter  remov- 
ed, and  the  apartment  of  the  patient  fprinkled  with 
vinegar,  which  will  remove  that  noxious  fmell  fo 
common  in  the  advanced  ftage  of  this  difeafe. 

We  come  now  to  the  different  ftimuli  that  are 
advifed  -,  and  the  firft  that  claims  our  attention  is 
wine.  This  is  almoft  always  grateful  to  the  pa- 
tient, and  fits  eafy  upon  his  ftomach.  It  ought  to 
be  given  pure,  and  the  quantity  muft  depend  upon 
circumftances.  I  firft  tried  it  in  fmall  portions, 
gradually  enlarging  the  dofe  as  the  patient  could 
bear  it.  Good  Port  wine  was  fometimes  ufed. 
Some  people,  after  continuing  the  ufe  of  wine  for 
a  few  days,  took  a  diflike  to  it :  I  then  changed 
the  ftimulus,  and  gave  brandy,  or  fpirits,  diluted 
with  water » 


(       26       ) 

In  a  few  cafes,  the  patient  rejected  every  thing 
that  was  received  into  the  ftomach,  excepting  now 
and  then  milk  punch,  which  was  retained.  Fo^ 
mentations  and  rubefacients,  applied  to  the  abdo- 
men, frequently  removed  this  irritability, 

It  has  been  faid,  that  the  volatile  alkali  is  of 
little  ufe  in  difeafes  where  the  patient  is  much 
weakened  j  but  in  Scarlatina  I  have  found  it  very 
ferviceable.  It  ought  to  be  given  in  large  dofes ; 
combined  with  the  fpirits  of  lavander  compound, 
it  proved  an  excellent  cordial. 

Opium  is  next  to  be  mentioned.  In  fmall  dofes 
it  is  ftimulant.  It  ought  to  be  given  in  folution, 
fuch  as  the  tin&ura  thebaica.  Ten  or  fifteen  drops 
mould  be  given  every  two  or  three  hours.  When 
the  patient  is  in  a  continual  ftate  of  watching,  and 
has  refliefs  nights,  in  order  to  procure  fleep  we  may 
give  from  forty  to  lixty  drops.  This  I  frequently 
found  had  the  defired  eifecl,  and  refrefhed  the  fick 
exceedingly. 

Through  the  whole  courfe  of  the  difeafe  we 
ought  to  attend  particularly  to  the  patient's  diet : 


(       27       ) 

It  mould  be  nutritious.  Good  beef- {leak  Broth, 
or  the  juice  of  broiled  meat  exprefled  and  well  fea-- 
foned,  may  be  given,  beginning  with  fmall  quari* 
tities  often  repeated. 

The  patient's  bowels  muft  alfo  be  attended  to : 
They  ought  to  be  emptied  once  in  twenty-four 
hours,  by  a  clyfter,  if  nece/Tary. 

Where  the  debility  is  very  great,  bark  injections- 
ought  to  be  thrown  in.  Fomentations  of  fpirits 
Jhould  be  applied  to  the  extremities,  and  ftimulat- 
ing  cataplafms  to  the  feet, 

When  the  throat  and  fauces  are  much  fwdled^ 
the  linamentum  volatile  (compofed  of  olive  oil  and 
volatile  alkali)  may  be  frequently  rubbed  upon  the 
parts  affected.  With  refpecl  to  blifiers,  I  think 
there  is  fome  danger  in  their  application,  as  they  are 
fometimes  fucceeded  by  gangrene.  I  have  fem 
three  or  four  cafes  where  they  produced  mortifica- 
tion, and  occarloned  death.  If  they  are  applied, 
they  ought  to  remain  no  longer  on  the  throat  than 
to  ad  as  rubefacients.  But  the  volatile  alkali  an- 
fwers  every  purpofe, 

The 


(      28      ) 

The  mouth  and  fauces  mould  be  frequently 
warned  with  aftringent  gargles,  fuch  as  infurlon  or 
decoction  of  the  bark,  with  elixir  vitriol,  a  folution 
of  white  vitriol,  allum,  rofe  water,  &c. 

The  anafarcous  fwellings  which  fometimes  fuc- 
ceeded  the  Scarlatina  Anginofa,  I  found  relieved  by 
purgatives  and  diuretics  \  at  the  fame  time  the  pa- 
tient may  take  the  Peruvian  bark,  and  ufe  flich  ex- 
ercife  as  his  ftrength  will  admit  of. 

I  have  now  finimed  the  hiftory  and  cure  of  the 
Scarlatina  Anginofa.  If  it  is  inaccurate,  I  hope  I 
mail  be  excufed,  as  the  want  of  time  has  prevented 
my  paying  the  attention  to  it  which  I  could  have 
wifhed.  However,  I  truft  it  will  be  found  that  I 
have  attended  to  the  moft  effential  circumftances  of 
this  difeafe. 


FINIS, 


tfSgJJ'* 


